PsychoactivePsychoactive substancesubstance useusedisordersdisorders

Dr.Dr. Bodrogi AndreaBodrogi Andrea

Basic Basic conceptionsconceptions

PsychoactivePsychoactive substancesubstance: : compoundcompoundthatthat cancan alteralter oneone’’ss statestate ofof mindmind

ReinforcerReinforcer: : thatthat causescauses pleasantpleasant ororstopsstops unpleasantunpleasant conditionsconditions

AbuseAbuse

MaladaptiveMaladaptive useuse ofof thethe substancesubstance//ItIt interferesinterferes withwith thethe personperson’’ss lifelife, ,

causescauses harmharm inin socialsocial functioningfunctioning, , ininfamilyfamily lifelife, , healthhealth, , atcatc././

AddictionAddiction

CompulsiveCompulsive behaviouralbehavioural patternpattern ofof seekingseekingdrugsdrugs, , consumptionconsumption ofof drugsdrugs

CharacterizedCharacterized bybystrongstrong dsesiredsesire towardstowards thethe drugsdrugs, , andand

strongstrong tendencytendency toto thethe relapserelapse afterafter thethewithdrawalwithdrawal

ToleranceTolerance

The The dosedose ofof thethe drugdrug has has toto be be increasedincreased inin orderorder toto reachreach thethe desireddesired effecteffect

effecteffect ofofdrugdrug developsdevelops

LevelLevel ofof tolerancetolerance --------------------------------------------------effecteffect ofof

drugdrug doesndoesn’’tt developdevelop

DependenceDependence

WhenWhen thethe substancesubstance useuse is is reducedreduced oror ceasedceasedwithdrawalwithdrawal symptomssymptoms developdevelop

lacklack ofof withdrawalwithdrawal symptomssymptomsLevelLevel ofof dependencedependence ----------------------------------------------------------

withdrawalwithdrawal symptomssymptoms

TwoTwo typestypes -- physiologicalphysiological dependencedependencepsychologicalpsychological dependencedependence

CategoriesCategories ofof drugsdrugs

CNS CNS DepressantsDepressantsAlcoholAlcoholSedativesSedatives, , hypnoticshypnotics, , andand anxiolyticsanxiolytics

OpiatesOpiates StimulantsStimulantsHeroin Heroin AmphetaminesAmphetaminesMeperidineMeperidine MethylphenidateMethylphenidateCodeineCodeine CocaineCocaineHydromorphoneHydromorphone

CannabisCannabisHallucinogensHallucinogens

InhalantsInhalants

NeuropsychiatricNeuropsychiatric disordersdisorders duedue totoalcoholalcohol consumptionconsumption

DeliriumDelirium tremenstremensAlcoholicAlcoholic hallucinatoryhallucinatory statestateAlkoholicAlkoholic delusivedelusive disorderdisorder

Alcoholic personality changesAlcoholAlcohol--inducedinduced PersistingPersisting DementiaDementia

WernickeWernicke’’ss encephalopathyencephalopathyKorsakoffKorsakoff syndromesyndrome

DelDelíírium rium tremenstremens

Most Most severesevere formform ofof alcoholalcohol withdrawalwithdrawalAtAt 15 % 15 % ofof AlcoholicAlcoholic personspersons

UntreatedUntreated deliriumdelirium has a has a mortalitymortality raterate ofof20 %20 %

OccursOccurs afterafter prolongedprolonged andand heavyheavy alcoholalcoholconsumptionconsumption atat ceasecease oror reductionreduction ofof alcoholalcohol useuse

ProvokingProvoking factorsfactors cancan oftenoften be be seenseen((feverfever, , internalinternal disturbancedisturbance))

SymptomsSymptoms ofof deliriumdelirium

PsychicPsychic, , vegetativevegetative, , somaticsomatic symptomssymptoms

DsiturbanceDsiturbance ofof consciousnessconsciousness, , DesorientationDesorientationHallucinationsHallucinations ((visualvisual, , tactiletactile etcetc.) .)

PsychomotorPsychomotor agitationagitationTremblingTrembling, , sweatingsweatingHypertensionHypertension, , feverfever

IncreasedIncreased pulsepulse raterate, , inversioninversion ofof sleepingsleepingEpilepticEpileptic attacsattacs

TreatmentTreatment ofof deliriumdelirium

PreventionPreventionBenzodiazepinesBenzodiazepines

EnsureEnsure fluid fluid andand electroliteelectrolite ballanceballanceHighHigh caloriecalorie, , highhigh--carbohydratecarbohydrate dietdiet

suplementedsuplemented byby multivitaminsmultivitaminsTreatmentTreatment ofof internalinternal disordersdisorders, , infectionsinfections, ,

etcetc..

AlcoholicAlcoholic hallucinatoryhallucinatory statestate

AtAt prolongedprolonged andand heavyheavy alcoholalcohol--consumptionconsumption, ,

afterafter alcoholalcohol--abuseabuse oror ceasecease ofof alcoholalcoholconsumptionconsumption

AlcoholicAlcoholic hallucinatoryhallucinatory statestate

SymptomsSymptoms::HallucinationsHallucinations

ClearClear conunsciousnessconunsciousness, , keptkept orientationorientationSevereSevere anxietyanxiety

PersecutoryPersecutory delusionsdelusionsDelusionsDelusions ofof referencereference

AlteredAltered behaviourbehaviour byby thethe PsichoticPsichotic contentscontentsSuicadialSuicadial dangerdanger

AlkoholicAlkoholic delusivedelusive disorderdisorder

DelusionsDelusions ofof jealousyjealousy (most (most oftenoften))persecutorypersecutoryreferencereference

Alcoholic personality changes

Slowly progressing chronic psychicdistrubance involving all parts of personality

after prolonged alcohol consumption

Symptoms

Changeable mood, Superficial emotions, Burstsof angerSuperficial attachment to the familyLack of inhibitions, Lack of ethicDecreased critical sense, UnconscientiousnessIrritability, AgressivityDecreased adapting to the societyDecreased judgementDeterioration of intelelctual functions

AlcoholAlcohol--inducedinduced PersistingPersistingDementiaDementia

ReasonReason::DirectDirect neurotoxicneurotoxic effecteffect ofof alcoholalcohol

andand thiaminethiamine deficiencydeficiency

SymptomsSymptoms::DeteriorationDeterioration ofof intelelctualintelelctual functionsfunctions

ImpairedImpaired memorymemory, , ImpairedImpaired abilityability ofofabstractionabstraction

ImpairedImpaired judgementjudgement, , ImpairedImpaired problemsolvingproblemsolvingthinkingthinking

ImpairedImpaired orientationorientation

WernickeWernicke’’ss encephalopathyencephalopathy

ProlongedProlonged andand heavyheavy drinkingdrinkingAcuteAcute illnessillness

UsuallyUsually startsstarts beforebefore thethe KorsakoffKorsakoffsyndromesyndrome

AtAt 22--6% 6% ofof alcoholicalcoholic patientspatientsReasonReason ofof thethe illnessillness: :

ThiamineThiamine ((vitaminevitamine B1) B1) deficiencydeficiency

SymtpomsSymtpoms ofof WernickeWernicke’’encephalopathyencephalopathy

OcularOcular motilitymotility abnormalitiesabnormalitiesLateralLateral rectalrectal palsypalsy, , gazegaze palsypalsyDisturbanceDisturbance ofof consciousnessconsciousness

AtaxiaAtaxia

KorsakoffKorsakoff syndromesyndrome

ProlongedProlonged andand heavyheavy drinkingdrinkingChronicChronic illnessillness, , slowlyslowly progressingprogressing

StartsStarts afterafter WernickeWernicke encephalopathyencephalopathy, , ororwithoutwithout itit

SymptomsSymptoms ofof KorsakoffKorsakoff syndromesyndrome

MemoryMemory disturbancedisturbanceImpairedImpaired shortshort termterm memorymemory, , impairedimpaired

abilityability ofof learninglearning((ImmediateImmediate recallrecall, , andand longlong termterm memorymemory is is

relativelyrelatively keptkept))PatientPatient is is notnot ableable toto memorizememorize eveneven simplesimple

informationsinformationsReasonReason ofof thethe illnessillness: : ThiamineThiamine ((vitaminevitamine

B1) B1) deficiencydeficiency

ThiamineThiamine

ReasonReason ofof thiaminethiamine deficiencydeficiency::PoorPoor nutritionnutritionMalabsorptionMalabsorption

ThiamineThiamine is a is a cofactorcofactor forfor severalseveralimportantimportant enzymesenzymes

ItIt’’ss involvedinvolved inin thethe conductionconduction ofof thethe axonaxonpotentialpotential alongalong thethe axonaxon andand inin synapticsynaptic

transmissiontransmission

NeuropathologicalNeuropathological leasionsleasions ininWernickeWernicke –– KorsakoffKorsakoff SyndromeSyndrome

LeasonsLeasons areare simmetricalsimmetrical, , ParaventricularParaventricularMamillryMamillry bodiesbodies, , ThalamusThalamus, , HypothalamusHypothalamus

MidbrainMidbrain, , PonsPons, , MedullaMedullaFornixFornix, , CerebellumCerebellum

EffectsEffects andand consequencesconsequences ofofillegalillegal drugdrug useuse

EffectsEffects ofof opiateopiate useuse

-- flushingflushing -- orgasmicorgasmicsensationsensation inin thethe abdomenabdomen

-- euphoriaeuphoria -- calmnesscalmness

WithdrawalWithdrawal symptomssymptoms ofof opiatesopiates

lacrimationlacrimation rhinorrhearhinorrheasweatingsweating yawningyawninghot hot andand coldcold flashesflashes insomniainsomniamusclemuscle andand jointjoint painpain nauseanauseavomitingvomiting abdominalabdominal

crampscrampsseversever anxietyanxiety irritabilityirritability

EffectsEffects ofof stimulantsstimulants

elevatedelevated moodmood increasdincreasd energyenergyincreasedincreased alertnessalertness transienttransient psychosispsychosisdecreaseddecreased appetiteappetite

autonomicautonomic hyperarousalhyperarousal::-- tachicardiatachicardia-- elevatedelevated bloodblood pressurepressure

EffectsEffects ofof cocaincocain

euphoriaeuphoriadisinhibitiondisinhibition

enhancedenhanced senssens ofof masterymasterysexualsexual alartnessalartness

improvedimproved selfself esteemesteemrushrush (rapid (rapid onsetonset ofof euphoriaeuphoria))

tactiletactile hallucinationshallucinations ((cokecoke bugsbugs))

StimulantStimulant withdrawalwithdrawal

fatiguefatiguedepressiondepressionnightmaresnightmaresheadacheheadachesweatingsweating

musclemuscle crampscrampshungerhunger

HallucinogensHallucinogens

AgentsAgents, , thatthat induceinduce psychoticpsychotic--likelikeexperiencesexperiences, , hallucinationshallucinations, , perceptualperceptual

disturbancesdisturbances, , feelingfeeling ofof unrealityunreality

HallucinogensHallucinogens

LSD (LSD (lysergiclysergic acidacid diethylamidediethylamide))peyotlepeyotlemescalinemescalineMDMAMDMA

EffectsEffects ofof HallucinogensHallucinogens

AlterationsAlterations inin perceptionperception: : hallucinationshallucinations, , illusionsillusions

synthesiassynthesias((e.ge.g. . colorscolors areare brighterbrighter andand more more intenseintense oror

colorscolors maymay be be hearedheared andand soundssounds seenseen) ) EmotionsEmotions becomebecome intenseintense andand labilelabile

IntrospectionIntrospectionDepersonalisationDepersonalisation, , DerealizationDerealization

BadBad tripstrips

PatientPatient developdevelop markedmarked anxietyanxiety andandparanoia paranoia

FlashbackFlashback: a : a briefbrief reoccurrencereoccurrence ofof a a drugdrug inducedinduced experienceexperience

thatthat occursoccurs inin situationssituations unrelatedunrelated tototakingtaking thethe drugdrug

CannabisCannabis

CannabisCannabis derivativesderivatives areare producedproducedfromfrom thethe hemphemp CannabisCannabis sativasativa. . The The activeactive ingredientingredient is is thethe THC THC (delta(delta--99--tetrahydrocannabinol).tetrahydrocannabinol).The The illicitillicit psychoactivepsychoactive compoundcompound((marijuanamarijuana) is ) is probablyprobably thethe most most widelywidely usedused..

EffectsEffects

-- euphoriaeuphoria-- drowsinessdrowsiness

-- feelingfeeling ofof calmcalm-- feelingfeeling thatthat timetime has has slowedslowed

-- improvedimproved selfself coinfidencecoinfidence-- perceptualperceptual distortionsdistortions

-- paranoia (paranoia (suspiciosnesssuspiciosness))-- decreaseddecreased motor motor coordinatoncoordinaton

CosequencesCosequences

AmotivationAmotivation syndromesyndrome

MemoryMemory disturbancedisturbanceMarijuanaMarijuana impairsimpairs thethe transfertransfer ofof

materialmaterial fromfrom mediatemediate toto longlong termtermmemorymemory

InhalantsInhalants

ChemicalsChemicals, , thatthat producesproduces psychoactivepsychoactivevapoursvapours

airplaneairplane gluegluepaintpaint thinnerthinner

nailnail--polishpolish removerremovergasolinegasoline

manymany substancessubstances inin aerosolaerosol canscans

ActiveActive substancessubstances::ToluaneToluane, , acetoneacetone, , benzenebenzene, , otherother organicorganic

hydrocarbonshydrocarbons

EffectsEffects

excitationexcitation disinhibitiondisinhibitioneuphoriaeuphoria dizzinessdizzinessslurredslurred speechspeech ataxiaataxiadeliriumdelirium hallucinationshallucinationsdelusionsdelusions nystagmusnystagmusdoubledouble visionvisionAtAt higherhigher dosesdoses: : stuporstupor, , comacoma

ConsequencesConsequences

NeuromuscularNeuromuscular andand brainbrain damagedamage, , damagedamage toto thethe kidneyskidneys, , liverliver

duedue toto highhigh concentrationsconcentrations ofof heavyheavymetalsmetals

TherapyTherapy ofof addictiveaddictive disordersdisorders

ConnectedConnected therapeutictherapeutic chainchain fromfromdetixificationdetixification toto resocialisationresocialisation andand

rehabilitationrehabilitation

AimAim ofof treatmenttreatment::ImproveImprove abilityability toto communitycommunity andand socialsocial

functioningfunctioning

TherapyTherapy ofof addictiveaddictive disordersdisorders

DifferentDifferent methodsmethods inin treatmenttreatmentsincesince drugdrug abuseabuse isis

a a medicalmedical-- a a psychologicalpsychological andand-- sociologicalsociological problemproblem

TherapyTherapy

PharmacotherapyPharmacotherapy

PsychoterapyPsychoterapy

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